Legal Bulletin No. 231

Issued 3 October 2025

Welcome to the two hundred and thirty first edition of the Personal Injury Commission’s Legal Bulletin. Please see here for details about the legal citations used for the Commission’s decisions. The decisions listed below are now available on AustLII and will be available shortly, on Jade and Lexis Nexis. Any legislative updates are provided at the base of the Bulletin.

Presidential Member Decisions

Robs Extreme Construction Pty Ltd v Workers Compensation Nominal Insurer (icare) [2025] NSWPICPD 67

Workers compensation; the onus of proof in applications pursuant to section 145(3) of the Workers Compensation Act 1987; application of Raniere Holdings Pty Ltd v Daley [2005] NSWCA 121; 66 NSWLR 594; A1 Granny Flats v Workers Compensation Nominal Insurer [2023] NSWPICPD 69; appeals pursuant to section 352 of the Workplace Injury Management and Workers Compensation Act 1998; application of State of New South Wales v Culhana [2025] NSWCA 157; Warren v Coombes [1979] HCA 9; 142 CLR 531; Fox v Percy [2003] HCA 22; 214 CLR 118; Lee v Lee [2019] HCA 28; 266 CLR 129; Eppinga v Kalil [2023] NSWCA 287; May v Costaras [2025] NSWCA 178; credit finding where witness gave deliberately untrue evidence; Malco Engineering Pty Ltd v Ferreira (1994) 10 NSWCCR 117; appealable error should be material; Gerlach v Clifton Bricks Pty Ltd [2002] HCA 22; 209 CLR 478; Leichhardt Municipal Council v Seatainer Terminals Pty Ltd (1981) 48 LGRA 409, 419, quoted in Trazivuk v Motor Accidents Authority of New South Wales [2010] NSWCA 287; weight of evidence; notes of treating medical practitioners; application of Container Terminals Australia Ltd v Huseyin [2008] NSWCA 320; New South Wales Police Force v Winter [2011] NSWCA 330; Mason v Demasi [2009] NSWCA 227; ET-China.com International Holdings Ltd v Cheung [2021] NSWCA 24; 388 ALR 128; J & E Vella Pty Ltd v Hobson [2023] NSWCA 234; Paric v John Holland Constructions Pty Ltd [1984] 2 NSWLR 505; [1985] HCA 58; 59 ALJR 844; Held – the appeal is dismissed; the Certificate of Determination dated 14 February 2025 is confirmed.

Decision date: 24 September 2025 | Before: Deputy President Michael Snell

CJA v Secretary (Department of Education) [2025] NSWPICPD 68

Workers compensation; application for redaction or de-identification under rule 132 of the Personal Injury Commission Rules 2021; Held – pursuant to r 6 of the Personal Injury Commission Rules 2021, I dispense with the requirement in r 132(3)(c) that this application be made within seven days of the decision being issued; I extend time for the applicant to make application under r 132 to 19 September 2025; pursuant to r 132, I direct that the names of the applicant and the three lay witnesses referred to by the Member in the 2 September 2025 decision be de-identified; I direct that each be identified by pseudonyms.

Decision date: 25 September 2025 | Before: President Judge Phillips

Motor Accidents non-Presidential Member Decisions

Frogson v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPIC 250

Motor Accident Injuries Act 2017; claims assessment dispute as to whether the claim is not suitable for assessment under Division 7.6; insurer and claimant made an application matter be exempted on discretionary basis under section 7.34(1)(b) on the grounds that the claim involves issue of liability, including contributory negligence, fault, or causation; rule 99(3)(c) of the Personal Injury Commission Rules 2021 (PIC Rules); claimant lodged a claim for common law damages in respect of serious injuries sustained in a motor vehicle accident; claimant was a front seat passenger; insurer has disputed liability and alleged contributory negligence on behalf of the claimant at 30%; the insurer submitted the matter ought to be exempted and allowed to proceed in the appropriate forum where the legal and factual complexities can be properly considered, where a binding decision can be made, and where non-party witnesses can be compelled to give evidence; Held – determined the claim is not suitable for assessment under Division 7.6; recommended the claim be exempt from assessment by operation of subsection 7.34(1)(b) and rule 99 of the PIC rules; recommendation subsequently approved by the Division Head, as the President’s delegate.

Decision date: 4 June 2025 | Member: David Ford

Maqdasi Hanna v QBE Insurance (Australia) Limited [2025] NSWPIC 264

Motor Accident Injuries Act 2017; claimant brought a claim for nervous shock arising of death of father in a motor vehicle accident; claims lodged by two other siblings and claimant’s mother; claim for nervous shock and compensation to Relatives Act claim brought on behalf of youngest sibling (a minor) exempted from assessment; dispute as to contributory negligence; Held – facts surrounding deceased accident relevant to all five claims so appropriate evidence in one be evidence in the other to ensure consistency; claims should be heard concurrently; recommended claim be exempted from assessment; recommendation subsequently approved by the Division Head, as the President’s delegate.

Decision date: 12 June 2025 | Senior Member: Susan McTegg

Insurance Australia Limited t/as NRMA Insurance v Salfus [2025] NSWPIC 376

Motor Accident Injuries Act 2017 (MAI Act); Workers Compensation Act 1987 (1987 Act); claimant brought common law claim for injury sustained as a result of his attendance at a motor vehicle accident in his role as a rescuer with Fire and Rescue NSW; consent application for discretionary exemption; associated recovery proceedings in District Court under section 151Z of the 1987 Act; grounds of defence in motor accident claim mirror grounds of defence in proceedings under section 151Z of the 1987 Act; if claim proceeded to assessment in Commission and section 151Z proceedings in District Court risk of inconsistent findings of fact and determination; unnecessary duplication of resources and be contrary to the objects of the MAI Act and the Personal Injury Commission Act 2020; Held – complex factual and legal issues including issues of liability, fault, and causation; claim should be heard in District Court with associated proceedings under section 151Z of the 1987 Act; exemption recommended; recommendation subsequently approved by the Division Head, as the President’s delegate.

Decision date: 6 August 2025 | Senior Member: Susan McTegg

Karim v Allianz Australia Insurance Limited [2025] NSWPIC 481

Motor Accident Injuries Act 2017; miscellaneous claims assessment; whether claimant wholly or mostly at fault; sections 3.11 and 3.28; claimant sustained injury when he parked his car to pray on the grass verge and whilst exiting the vehicle moved backwards before hitting a tree injuring the claimant in the process; evidence supported a failure to engage the park position and handbrake of the vehicle; departure from the standard of care required of a person in the position of the claimant; Held – the claimant’s evidence and the comprehensive analysis of the operations and mode of the vehicle’s handbrake mechanism from an expert investigator; the claimant mostly at fault and contributory negligence greater than 61%.

Decision date: 11 September 2025 | Member: Elyse White

Hyland v Allianz Australia Insurance Limited [2025] NSWPIC 482

Motor Accident Injuries Act 2017; miscellaneous claims assessment; whether the motor accident was caused wholly or mostly by the fault of the claimant under sections 3.11 and 3.28; claimant was riding his motorcycle along a dirt road behind a fellow motorcyclist; the fellow motorcyclist rode over a tree/log lying on the roadway which bounced upwards resulting in the claimant failing to navigate across it; claimant lost control of his motorcycle, was dislodged, fell to the ground, and sustained serious injuries; determined the claimant was not wholly or mostly fault determined the degree of the claimant’s contributory negligence assessed at 25%; Held – motor accident not caused wholly or mostly by the fault of the claimant; claimant entitled to payment of legal costs assessed at the maximum regulated fee.

Decision date: 16 September 2025 | Member: David Ford

AAI Limited t/as AAMI v Davidson [2025] NSWPIC 483

Motor Accident Injuries Act 2017; settlement approval; $180,000; non-economic loss only; 91-year-old pensioner; insurer conceded entitlement to non-economic loss; injuries include multiple fractures (chest and pelvis, right S1 and 2), and a pulmonary embolus; subsequent falls unrelated requiring surgery; background of pre-existing medical conditions and subsequent falls impacting on claimant’s abilities; need to move to nursing home unrelated to injuries sustained in subject motor vehicle accident; settlement complied with clause 7.37 of the Motor Accident Guidelines version 9.3; settlement approved under section 6.23(2)(b).

Decision date: 16 September 2025 | Member: Shana Radnan

BVV v QBE Insurance (Australia) Limited [2025] NSWPIC 496

Motor Accident Injuries Act 2017; claim for damages; claimant’s application for assessment of liability and damages; claimant experienced hypoglycaemic episode while driving causing accident; insurer denied liability on basis he was the owner and driver of the vehicle and cannot recover damages; claimant alleged failure of airbag to deploy was negligence and insurer should sue Toyota; Held – accident was a motor accident; accident caused by claimant’s medical episode and he was not at fault; accident was not caused by anyone else’s fault (airbag deployment relevant to cause of injury not cause of accident); accident was a no fault accident; as the driver of the vehicle that caused the accident section 5.4(1) prevents the claimant from recovering damages; decision in statutory benefits claim referred to; BVV v QBE Insurance (Australia) Limited, and Whitfield v Melenewycz cited in respect of no-fault accident.

Decision date: 23 September 2025 | Member: Belinda Cassidy

Workers Compensation non-Presidential Member Decisions

Ahmad v KWF Pty Ltd [2025] NSWPIC 484

Workers Compensation Act 1987; claim for the cost of surgery for anterior and posterior two level spinal fusion; Rose v Health Commission New South Wales, Diab v NRMA Limited considered; Held – order that the respondent pay the section 60 expense of and incidental to surgery.

Decision date: 17 September 2025 | Member: Catherine McDonald

Gharehdaghi v Trafalgar Group Pty Ltd [2025] NSWPIC 485

Workers Compensation Act 1987; medical expenses; claim for future surgery; sacro-iliac joint fusion; whether surgery reasonably necessary; Diab v NRMA Ltd applied; applicant had explored other options; applicant’s treating surgeon and independent medical expert of the view that treatment reasonably necessary; lack of recent radiology considered; Held – respondent pay the costs of left-sided fusion of sacroiliac joint.

Decision date: 17 September 2025 | Member: Parnel McAdam

AH KAW v Sydney Wideform Australia Pty Ltd (in liq) & Ors [2025] NSWPIC 486

Workers Compensation Act 1987; claim for weekly compensation; worker/deemed worker disputed inter alia; Stevens v Brodribb Sawmilling Co Pty Ltd considered; Held – applicant was a deemed worker; award for applicant for weekly compensation.

Decision date: 17 September 2025 | Member: Michael Wright

Stanton v F.L.T (NSW) Pty Ltd [2025] NSWPIC 487

Workers Compensation Act 1987; section 60; claim for further surgery for accepted lumbar spine injury; acceptance that surgery is reasonably necessary; whether proposed surgery results from accepted injury; pre-existing degenerative pathology; adequacy of evidence on causation and material contribution to need for surgery; Kooragang Cement Pty Ltd v Bates, Murphy v Allity Management Services Pty Ltd, and Nguyen v Cosmopolitan Homes considered and applied; Held – applicant failed to discharge onus of proof that there is a material contribution from the accepted injury to the applicant’s current condition and need for surgery; award for respondent.

Decision date: 17 September 2025 | Member: Kathryn Camp

Hargrave v Skelwork Pty Ltd [2025] NSWPIC 488

Workers Compensation Act 1987; application claimed costs of surgery to cervical spine and left shoulder; applicant sought only costs of surgery to cervical spine and general order for treatment of left shoulder; dispute as to injury; applicant unsure of date of injury; documents lodged by respondent established applicant was not working for respondent on alleged date of injury; injury may have occurred some weeks later; application amended to claim alternative dates of injury; summonses to give evidence served on applicant’s supervisor and respondent’s operations manager and director of the respondent; no application made to cross-examine applicant or call evidence from witnesses under summons; application by respondent to dispute “notice” and “claim” refused; respondent did not dispute reasonable necessity of proposed surgery to cervical spine; consideration of application of section 59A, Mateus v Zodune Pty Limited trading as Tempo Cleaning Services, State of New South Wales v Hunt, Humphrey v Woolworths Group Limited, and Flying Solo Properties Pty Ltd t/as Artee Signs v Collet; Held – applicant sustained injury to neck and left shoulder; employment was a substantial contributing factor to injury; declaration as to costs of surgery to cervical spine and treatment of left shoulder.

Decision date: 17 September 2025 | Senior Member: Kerry Haddock

D'amico v State of New South Wales (NSW Police Force) [2025] NSWPIC 489

Workers Compensation Act 1987; claim for permanent impairment lump sum compensation pursuant to section 66 and compensation for pain and suffering pursuant to section 67; whether applicant sustained injury to her bilateral wrists, right thumb, right knee, and left ankle arising out of her employment with the respondent pursuant to section 4(b)(i) and section 4(b)(ii); Held – applicant did sustain injury to her bilateral wrists, right thumb, right knee, and left ankle arising out of her employment with the respondent pursuant to section 4(b)(i); applicant did not sustain these injuries pursuant to section 4(b)(ii); matter remitted to the President to be referred to a Medical Assessor for assessment of whole person impairment; matter to be listed for further conference following the issue of the Medical Assessment Certificate in relation to the claim pursuant to section 67; the respondent to pay the applicant’s costs as agreed or assessed.

Decision date: 17 September 2025 | Member: Karen Garner

Modderno v Proyou Business Advisory Pty Ltd [2025] NSWPIC 490

Workers Compensation Act 1987; claim for weekly compensation and payment of medical and related treatment expenses as a result of psychological injury; respondent admitted injury and incapacity denied liability relying on section 11A(1) being reasonable action taken or proposed to be taken by the employer with respect to discipline; Held – respondent failed to discharge its onus to establish the defence under section 11A(1); award for the applicant.

Decision date: 17 September 2025 | Member: Michael Moore

Dickens v Westpac Banking Corporation [2025] NSWPIC 492

Workers Compensation Act 1987; accepted psychological injury; defence under section 11A(1) raised with respect to retrenchment; weekly benefits and treatment and related expenses disputed; Held – the respondent has not discharged its onus of establishing on the balance of probabilities the applicant’s accepted psychological injury was wholly or predominantly caused by reasonable action taken by or on its behalf with respect to retrenchment within the meaning of section 11A(1); weekly benefits and medical expenses payable.

Decision date: 19 September 2025 | Member: Fiona Seaton

Marshall v Royal Freemasons' Benevolent Institution [2025] NSWPIC 493

Workers Compensation Act 1987; claim for medical expenses; whether the applicant suffered injury to her hips in an accepted work-related fall; applicant suffered an accepted lumbar spine injury in a fall from a chair at work; there is no issue she suffered a lumbar spine injury in that fall; the applicant claims the costs of past and future treatment to not only the lumbar spine but also her bilateral hips, and for a right ankle/Achilles tendon strain (consequential); no issue was taken with any of the treatment modalities claimed; the dispute centred on the presence of any alleged injury and/or consequential condition; Held – having regard to the totality of the lay and medical evidence the applicant suffered bilateral hip injuries in the fall at issue; the applicant has not discharged her onus of proof in establishing her Achilles tendon/ankle strain occurred as a consequence of her injury; the respondent is ordered to pay the applicant’s reasonably necessary medical and treatment expenses in connection with her lumbar spine and hip injuries; award for the respondent on the claimed consequential condition to the right ankle/Achilles tendon.

Decision date: 23 September 2025 | Member: Cameron Burge

Encourage Group Pty Ltd v Workers Compensation Nominal Insurer (iCare) & Anor [2025] NSWPIC 495

Workers Compensation Act 1987; application pursuant to section 145 by the applicant (an uninsured employer) for a determination as to its liability to reimburse the Workers Compensation Nominal Insurer for payments it made in respect to injury to the second respondent; Held – the second respondent sustained injury to her left wrist pursuant to section 4(a) while in the employ of the applicant; the applicant concedes it did not have a policy of workers compensation insurance for injury; the applicant is liable to reimburse the Workers Compensation Nominal Insurer for the payments it has made as claimed pursuant to section 145 in the amount of $23,878.87.

Decision date: 23 September 2025 | Member: Josephine Bamber

Motor Accidents Medical Review Panel Decisions

AAI Limited t/as Suncorp Insurance v Bjelan [2025] NSWPICMP 708

Motor Accident Injuries Act 2017; degree of permanent impairment disputes; claimant’s vehicle was struck in the rear by the insured vehicle while both were still moving forward; claimant wore a seatbelt; claimant did not go to hospital and was driven home by his friend; claimant suffered injuries to his neck, left shoulder, and lower back; claimant was referred for physiotherapy; also claims to have suffered psychological injuries; claimant says that he was frightened by the accident, became anxious and depressed, and developed a huge sense of anger; claimant says that he has become aggressive and has anger management issues as a result of the accident; Medical Assessor (MA) certified 13% whole person impairment (WPI) under the psychiatric impairment rating scale (PIRS); Held – Review Panel made a similar diagnosis but found 7% WPI on basis of slightly lower score for self-care and personal hygiene category; certificate revoked.

Decision date: 15 September 2025 | Panel Members: Member Gary Victor Patterson, Dr Christopher Canaris, and Dr Himanshu Singh | Injury module: Mental and Behavioural

QBE Insurance (Australia) Limited v Knight [2025] NSWPICMP 709

Motor Accident Injuries Act 2017; degree of permanent impairment disputes; claimant was riding his motorbike; claimant was wearing full protective kit with helmet, gloves, and riding boots; claimant was travelling at about 60 km/h when a marked police vehicle entered the road to do a u-turn; claimant braked sharply but could not avoid hitting the police vehicle; claimant was transported by ambulance to hospital where he remained for about a week; claimant says that he suffered left rib fractures, left hip fracture, exacerbation to pain in his right shoulder, exacerbation to pain in his left shoulder, post-traumatic osteoarthritis in both ankles, development of pain in his left groin region, spinal injury, impact injury to head, collar bone fracture, exacerbation to pre-existing vertigo and tinnitus, and psychological sequelae; claimant says that he suffers from a number of consequential disabilities; Medical Assessor found 13% whole person impairment (WPI) for left shoulder, left ankle, and hip; Held – certificate confirmed.

Decision date: 15 September 2025 | Panel Members: Member Gary Victor Patterson, Dr David Gorman, and Dr Thomas Rosenthal | Injury module: Spine, Upper Limb, and Lower Limb

Younes v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 710

Motor Accident Injuries Act 2017; permanent impairment; review; insurer disputed causation and permanent impairment; Commission referred upper limb injuries with cervical spine injury to assess permanent impairment; Medical Assessor’s certificate assessed 0% permanent impairment; referred for review; re-examination; claimant was cooperative and consistent; accident was capable of causing all referred injuries; 6% permanent impairment; different clinical findings; Held – different permanent impairment findings to original assessment; Review Panel revoked original medical assessment certificate; permanent impairment not greater than 10%.

Decision date: 15 September 2025 | Panel Members: Member Terence O'Riain, Dr Margaret Gibson, and Dr Mohammed Assem | Injury module: Spine, and Upper Limb

Sulusulu v QBE Insurance (Australia) Limited [2025] NSWPICMP 711

Review of decision of Medical Assessor (MA) who assessed the claimant as having 2% whole person impairment (WPI) and diagnosed a post-traumatic stress disorder with a dysthymic disorder; claimant involved in an accident; issue of whether the claimant’s psychiatric disability was affected by a pre-existing psychiatric disorder; the claimant's solicitors lost contact with their client and on failure of the claimant to attend a medical examination by the Review Panel it was only possible for the review of the certificate and reasons of the MA to proceed on the papers; Held – Review Panel assessed the claimant as having a 4% WPI and diagnosed a post-traumatic stress disorder in partial remission and an exacerbation of a persistent depressive disorder; certificate of MA revoked.

Decision date: 15 September 2025 | Panel Members: Member Alexander Bolton, Dr Matthew Jones, and Dr John Baker | Injury module: Mental and Behavioural

Siyavong v AAI Limited t/as GIO [2025] NSWPICMP 715

Motor Accident Injuries Act 2017; assessment of whole person impairment (WPI); claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) assessed 8% whole person impairment (WPI) as a result of major depressive disorder and post-traumatic stress disorder; claimant sought review; claimant alleged the class 1 assessment for self-care and personal hygiene should be class 2; Held – post-traumatic stress disorder and persistent major depressive disorder caused by accident; self-care and personal hygiene assessed as class 2, social and recreational activities assessed as class 2, travel assessed as class 2, social functioning assessed as class 2, concentration, persistence and pace assessed as class 2, and adaption assessed as class 1; aggregate score 11; WPI caused by accident is assessed at 5%; certificate of MA revoked.

Decision date: 16 September 2025 | Panel Members: Senior Member Susan McTegg, Dr Wayne Mason, and Dr Alan Doris | Injury module: Mental and Behavioural

Holbert v QBE Insurance (Australia) Limited [2025] NSWPICMP 716

Motor Accident Injuries Act 2017; permanent impairment; review; insurer disputed causation and permanent impairment; significant psychological and physical injuries before accident; Commission referred psychiatric condition to assess permanent impairment; Medical Assessor’s certificate assessed 8% permanent impairment; referred for review; re-examination; claimant was cooperative and consistent; accident was capable of causing all referred injuries; 5% permanent impairment; different clinical findings; Held – different permanent impairment findings to original assessment; Review Panel revoked original medical assessment certificate; permanent impairment not greater than 10%.

Decision date: 16 September 2025 | Panel Members: Member Terence O’Riain, Dr Paul Friend, and Dr Alan Doris | Injury module: Mental and Behavioural

Abdul-Raouf v QBE Insurance (Australia) Limited [2025] NSWPICMP 717

Motor Accident Injuries Act 2017; assessment of threshold psychological injury under section 1.6(3); claimant suffered injury in a motor vehicle accident; psychological conditions existing before accident; Medical Assessor found the claimant did not sustain a psychological injury as a result of the accident; claimant sought review; Held – claimant had sustained exacerbations of pre-existing post-traumatic stress disorder, cannabis use disorder, and somatic symptom disorder (predominant pain) caused by the accident; certificate revoked; not a threshold injury.

Decision date: 17 September 2025 | Panel Members: Member Terence O’Riain, Dr Wayne Mason, and Dr Alan Doris | Injury module: Mental and Behavioural

Sam v QBE Insurance (Australia) Limited [2025] NSWPICMP 722

Motor Accident Injuries Act 2017; threshold injury disputes; claimant was stationary waiting for a vehicle in front to park; insured vehicle collided with the rear of the claimant’s vehicle; claimant went to hospital later that day initially with few complaints; diagnostic scans were performed and he was sent home for treatment by his GP; claimant was complaining of severe neck pain, pain between his shoulders, and severe lower back injury with numbness/pins and needles extending down both arms; claimant was working as a cleaner; claimant ceased work about two months after the subject accident after suffering a fall at work; Medical Assessor certified that claimant did not suffer a psychological/psychiatric injury as a result of the accident; Held – Review Panel found claimant suffered chronic adjustment disorder secondary to chronic pain with anxiety and depression; certificate revoked.

Decision date: 18 September 2025 | Panel Members: Member Gary Victor Patterson, Dr Ronald Gill, and Dr Christopher Rikard-Bell | Injury module: Mental and Behavioural

Nigro v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 723

Motor Accident Injuries Act 2017; review of certificate and reasons of Medical Assessor (MA); threshold injury assessment and assessment of whole person impairment (WPI); claimant claimed injury to his cervical and lumbar spines, his right shoulder as well as a tear to his right shoulder supraspinatus muscle as a result of the accident; insurer denied this on the basis the condition was degenerative; claimant had been involved in an earlier work accident in 2003 involving mainly his lumbar spine and had not worked since; issue about the age of the shoulder tear; complaint by the claimant at the time of the accident and immediately thereafter of acute pain in the shoulder; Held – Review Panel satisfied that the claimant had a non-threshold injury of his right shoulder and that this not a degenerative condition; Review Panel assessed 5% WPI for the cervical spine and 6% WPI for the shoulder; total WPI of 11%; certificate of MA revoked.

Decision date: 19 September 2025 | Panel Members: Member Alexander Bolton, Dr Margaret Gibson, and Dr Tai-Tak Wan | Injury module: Spine, and Upper Limb

Insurance Australia Limited t/as NRMA Insurance v BZE [2025] NSWPICMP 725

Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant was in the front passenger side of a parked utility vehicle when it was rear-ended at speed by another vehicle; claimant sustained psychiatric injury; original Medical Assessor diagnosed post-traumatic stress disorder and assessed 15% whole person impairment (WPI); Held – Review Panel confirmed the diagnosis of post-traumatic stress disorder; degree of permanent impairment assessed under the psychiatric impairment rating scale (PIRS) at 7% WPI; pre-existing psychiatric condition effectively controlled by medication warranted 2% WPI deduction; total WPI related to the motor accident is 5%; MAC revoked.

Decision date: 19 September 2025 | Panel Members: Member Jeremy Lum, Dr Paul Friend, and Dr Matthew Jones | Injury module: Mental and Behavioural

Insurance Australia Limited t/as NRMA Insurance v Haklane [2025] NSWPICMP 731

Motor Accidents Compensation Act 1999; insurer’s application for review of Medical Assessor’s (MA) determination that lumbar spine surgery was reasonable and necessary and related to the injuries caused by the accident; significant dispute as to causation of injury due to earlier accidents and longstanding lumbar spine complaints; re-examination; Held – accident caused a lower back injury; diagnosis of lower back injury was aggravation of pre-existing spondylolisthesis; surgery needed to address unrelating lower back pain caused by the aggravation after conservative measures exhausted; certificate of MA confirmed; AAI Limited t/as AAMI v Phillips followed in respect of causation of treatment; Diab v NRMA Ltd followed in respect of criteria for reasonable treatment.

Decision date: 22 September 2025 | Panel Members: Member Belinda Cassidy, Dr Tai-Tak Wan, and Dr David Gorman | Treatment Type: Surgery

Insurance Australia Limited t/as NRMA Insurance v Haklane (No 2) [2025] NSWPICMP 732

Motor Accidents Compensation Act 1999; insurer’s application for review of Medical Assessor’s (MA) further assessment of whole person impairment (WPI); significant dispute as to causation of injury due to earlier accidents and longstanding lumbar spine complaints; issue of WPI assessment complicated by surgery that was also disputed; re-examination; Held – Review Panel relied on findings in related treatment dispute that surgery was reasonable and necessary and related to the accident resulting in DRE IV impairment (less DRE II impairment for pre-existing condition); surgical scarring assessed at 1%; combined WPI at 16%; certificate of MA revoked.

Decision date: 22 September 2025 | Panel Members: Member Belinda Cassidy, Dr Tai-Tak Wan, and Dr David Gorman | Injury module: Spine, Upper Limb, and Digestive System

Peacock v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 733

Motor Accident Injuries Act 2017; review of medical assessment; whole person impairment (WPI); exacerbation of pre-existing post-traumatic stress disorder; pre-existing impairment; claimant receiving disability support pension at date of accident; prior workers compensation claim; prior mood stabilisation medications; pre-existing bipolar affective disorder; rear end collision; pre-accident NDIS support; borderline personality disorder; long-term cognitive problems; exacerbation of chronic post-traumatic stress disorder; exacerbation of possible cluster B personality; Held – medical assessment certificate revoked; WPI assessed at 8%.

Decision date: 23 September 2025 | Panel Members: Member Hugh Macken, Dr Matthew Jones, and Dr Christopher Rickard-Bell | Injury module: Mental and Behavioural

QBE Insurance (Australia) Limited v Lucanovic [2025] NSWPICMP 734

Motor Accident Injuries Act 2017; permanent impairment; review; insurer disputed causation and permanent impairment; alleged significant psychological condition before accident; Commission referred psychiatric condition to assess permanent impairment; Medical Assessor’s (MA) certificate assessed 17% permanent impairment; referred for review; re-examination; claimant was cooperative and consistent; accident was capable of causing all referred injuries; 8% permanent impairment; different clinical findings; Held – different permanent impairment findings to original assessment; Review Panel revoked original certificate; permanent impairment not greater than 10%.

Decision date: 23 September 2025 | Panel Members: Member Terence O’Riain, Dr Christopher Canaris, and Dr Anuk Gupta | Injury module: Mental and Behavioural

Allianz Australia Insurance Limited v CZZ [2025] NSWPICMP 738

Motor Accident Injuries Act 2017; insurer’s review of Medical Assessment Certificate (MAC) under section 7.26; threshold injury dispute; psychiatric injury; Medical Assessor (MA) diagnosed aggravation of an alcohol use disorder now in remission; pre-existing condition; issues of psychiatric impairment rating scale (PIRS) categories; Held – both MA’s re-examined the claimant and took detailed history of claimant’s alcohol consumption; Review Panel found accident caused or contributed to a psychological injury; MA’s diagnosed major depressive disorder and exacerbation of an alcohol use disorder; both of which were not threshold injuries; MAC revoked; no issue of principle.

Decision date: 24 September 2025 | Panel Members: Member Belinda Cassidy, Dr Paul Friend, and Dr Surabhi Verma | Injury module: Mental and Behavioural

Gunaweera Mudalige v AAI Limited t/as GIO [2025] NSWPICMP 739

Motor Accident Injuries Act 2017; medical dispute; review of medical assessment; dispute as to whether treatment and care is reasonable and necessary and causally related to the motor accident; injury to lumbar spine; issue of causation in respect of elbows which the claimant alleges were injured due to her altering her activities on account of back injury; context of pre-existing epidondylitis in the elbows; closed period of commercial domestic assistance between June and November 2023 in dispute; Held – medical certificate confirmed; elbow injuries not caused by the motor accident; right elbow condition being the main complaint during the relevant period; treatment not reasonable and necessary and not causally related to the injuries caused by the motor accident.

Decision date: 24 September 2025 | Panel Members: Member Elizabeth Medland, Dr Michael Couch, and Dr Margaret Gibson | Treatment Type: Domestic Assistance

Workers Compensation Medical Appeal Panel Decisions

Strong v Woolworths Group Ltd [2025] NSWPICMP 713

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of impairment of the lumbar spine under DRE Lumbar Category III; Appeal Panel found that the applicant did not have cauda equina syndrome and there was no error in the assessment of the lumbar spine; Appeal Panel satisfied no error in assessment of activities of daily living; no assessment of scarring; Appeal Panel found error as claim was made in respect of scarring; worker re-examined and assessed at 1% whole person impairment (WPI) for scarring; Held – MAC revoked.

Decision date: 16 September 2025 | Panel Members: Member Carolyn Rimmer, Dr Mohammed Assem, and Dr James Bodel | Body system: Lumbar Spine, and Scarring

State of New South Wales (Hunter New England Local Health District) v Walton [2025] NSWPICMP 714

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant employer alleged demonstrable error and assessment based on incorrect criteria by Medical Assessor (MA) by failing to apply a deduction for a pre-existing condition in the assessment of whole person impairment (WPI) of thoracic spine and failing to provide adequate reasons for that omission; reference to Cole v Wenaline Pty Ltd,and Neader v The Trustee for Vestito Unit Trust t/as TS 14 Plus Australia Pty Ltd; Held – MA failed to provide adequate reasons for not making a deduction for a pre-existing condition and there was ambiguity in the reasons which were provided; MAC revoked.

Decision date: 16 September 2025 | Panel Members: Member John Isaksen, Dr James Bodel, and Dr Alan Home | Body system: Thoracic Spine, Left Lower Extremity, and Scarring

Alder-Blackmore v Kurri Kurri Community Services Ltd [2025] NSWPICMP 718

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment by Medical Assessor (MA) of 7% whole person impairment (WPI) for primary psychiatric condition; appeal under sections 327(3)(c) and (d) for failure to comply with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed 1 March 2021 (the Guidelines) in respect of the history of suicidal ideation and alcohol use disorder; Appeal Panel satisfied that the MA complied with the Guidelines; Appeal Panel satisfied that grounds of appeal in relation to the assessments in the psychiatric impairment rating scale (PIRS) categories (self-care and personal hygiene, social and recreational activities, social functioning, and concentration, persistence and pace) were not made out; Held – MAC confirmed.

Decision date: 17 September 2025 | Panel Members: Member Carolyn Rimmer, Dr Douglas Andrews, and Dr Graham Blom | Body system: Psychological/Psychiatric

State of New South Wales (NSW Health Pathology) v Wu [2025] NSWPICMP 719

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of permanent impairment as a result of psychological injury; psychiatric impairment rating scale (PIRS) tables for social and recreational activities, social functioning, and employability; assessment under section 323 and relationship with PIRS; diagnosis of pre-existing condition under DSM 5; Held – MAC confirmed.

Decision date: 18 September 2025 | Panel Members: Member Catherine McDonald, Dr Douglas Andrews, and Dr John Baker | Body system: Psychological/Psychiatric

Peek v Secretary, Department of Education [2025] NSWPICMP 720

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of permanent impairment for psychological injury; psychiatric impairment rating scale (PIRS) for social and recreational activities; Ballas v Department of Education, Tasevski v Westpac Banking Corporation, and Tradieh v LM Hayter & Sons Pty Ltd; Held – MAC confirmed.

Decision date: 18 September 2025 | Panel Members: Member Catherine McDonald, Dr Graham Blom, and Dr Ash Takyar | Body system: Psychological/Psychiatric

Wheeler v William Angus Scott & Migella Margaret Scott t/as Scotts Spreading Services [2025] NSWPICMP 721

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); workers compensation; Medical Assessor fell into error; application of incorrect criteria to history taken; re-examination; Held – MAC revoked; new certificate issued.

Decision date: 18 September 2025 | Panel Members: Member Mitchell Strachan, Dr David Crocker, and Dr Doron Sher | Body system: Right Lower Extremity, Lumbar Spine, and Scarring (TEMSKI)

Hynoski v Hassy Investments Pty Ltd [2025] NSWPICMP 729

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); the appellant submits that the Medical Assessor erred in the assessments in respect of three of the psychiatric impairment rating scale (PIRS) categories; Held – Appeal Panel found no errors; the assessments were consistent with the evidence; MAC confirmed.

Decision date: 22 September 2025 | Panel Members: Member Deborah Moore, Dr Douglas Andrews, and Dr Michael Hong | Body system: Psychological/Psychiatric

Ramlu v Regal Health Pty Ltd [2025] NSWPICMP 730

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal by claimant against lumbar DRE I assessment; whether asymmetric range of motion shown; whether failure to record investigations an error; Held – claimant relied on misapprehension as to the methodology of measuring range of motion in lumbar spine; Table 15.3 of the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5) considered and reproduced; claimant relied on incorrect expert opinion; Wingfoot Australia Partners Pty Ltd v Kocak considered and applied; failure to record investigations in MAC inconsequential; MAC revoked to correct obvious mathematical error.

Decision date: 22 September 2025 | Panel Members: Member John Wynyard, Dr Chris Oates, and Dr James Bodel | Body system: Left Lower Extremity, and Lumbar Spine

Barcala v Secretary, Department of Education [2025] NSWPICMP 737

Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); failure to provide adequate reasons; Wingfoot Australia Partners Pty Limited v Kocak applied; demonstrable error; Held – Medical Assessor fell into error; re-examination; MAC revoked; new MAC issued.

Decision date: 23 September 2025 | Panel Members: Member Mitchell Strachan, Dr Christopher Oates, and Dr Roger Pillemer | Body system: Cervical Spine, Right Upper Extremity, and Thoracic Spine

Motor Accidents Merit Review Decision

Mazry v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMR 28

Motor Accident Injuries Act 2017; no dispute claimant is an earner and was injured in the motor accident; whether claimant entitled to weekly payments of statutory benefits; calculation of pre-accident weekly earnings (PAWE); whether claimant received director fees from the company; absence of personal income tax return; company tax documents do not include director fees; Held –not satisfied the claimant was paid director fees; PAWE calculated as nil; insurer’s reviewable decision affirmed.

Decision date: 24 September 2025 | Merit Reviewer: Jeremy Lum

This publication is for information only. The publication is not legal advice.  The information provided is not a substitute for reading the decisions. The Commission does not accept liability for the information in this publication or for way the information is used.

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